Complying with a court ruling, the state Agency for Persons with Disabilities on Thursday held a hearing about a mathematical formula that helps determine how much money is spent on services for developmentally disabled Floridians.
The 1st District Court of Appeal in July found that the agency did not properly carry out a law that created what are known as "iBudgets." The law was designed to provide set amounts of money to people with developmental disabilities, depending on their needs, and then give them flexibility in how the money is spent on services.
The court found that the Agency for Persons with Disabilities improperly used the formula, or algorithm, to make decisions that led to lower funding for some people.
Now the agency is increasing the money available for services for about 14,000 people in the iBudget program.
"We really do want this to be an open dialogue," agency Deputy Director for Programs Denise Arnold told about 100 advocates, service providers, support coordinators and family members at the hearing. "We will make it better."
The formula is intended to provide an equitable distribution of available resources among people who are in the program. It's based on an evaluation process that includes the age and living situation of the person being served, along with an assessment called a QSI that scores his or her ability to perform functions such as maintaining hygiene.
Once the individual budget is determined, the client and caregivers can choose how to spend the money on services and providers.
The purpose of the hearing was to adjust the formula to better reflect the degree of care that people in the iBudget program require.
"The test for getting more services is pretty stiff," said Nancy Wright, an attorney representing The Arc of Florida, an advocacy group for people with developmental disabilities. "If you took that literally, to its extreme, that would mean if you kept somebody safe sitting in a room watching TV all day … maybe you don't need more than that. But all of us know that if you're going to look at mental health and quality of life, you've got to look at more than that."
Speakers said the formula should be altered to include more frequent assessments of people's needs, because cognitive and physical abilities tend to deteriorate in middle age.
"I think (age) 50 is a critical cut-off point," said Janice Phillips, chairwoman of the Association of Support Coordination Agencies of Florida.
Other speakers said factors such as where a person lives and the quality of his or her support coordinator affected how far the money would stretch for services.
"Some support coordinators cared more, did a better job of advocating for their clients, and some didn't even take the time to see if (the assessment) was accurate or if their client needed additional advocacy," said Julie McNabb, chief executive officer of Horizons of Okaloosa County, a service provider. "This is supposed to be a scientific process … but as soon as you put the people into it, the science kind of goes out the window."
McNabb also said it's probably a conflict of interest to have the Agency for Persons with Disabilities administering the QSI assessment "and also controlling the pocketbook."
Mark Barry, executive director of The Arc Nature Coast, urged the agency to make the iBudget process more transparent.
"That's a big part of where and how we got off track," he said.
The cost of complying with the appellate court ruling could be as much as $120 million, but Arnold said the implications for her agency's budget were "unknown at this point."
"We're trying to look at how we implemented the algorithm in the past and take some improvements and suggestions from the stakeholders to see if we can run something that matches more individuals' needs," she said after the hearing. "We're trying to approach this from individual needs right now, not what the cost is of things necessarily right now."
The agency is expected to turn to the Legislature for help with the issue next year, which could involve additional funding or changes in state law.
